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Discusses the causes and symptoms of bladder cancer. Covers how it is diagnosed and treatment options, including surgery, chemotherapy, and radiation therapy. Offers home treatment suggestions to manage side effects like nausea and sleep problems.

Bladder Cancer

Topic Overview

What is bladder cancer?

Cancer is the growth of
abnormal cells in the body. These extra cells grow together and form masses,
called tumors. In bladder cancer, these growths happen in the bladder.

Bladder cancer can often be successfully treated if it
is found and treated early. And most bladder cancer is found early.

This topic is about the most common type of bladder cancer, called transitional cell cancer. This is cancer that starts in the inner layer of the bladder. It happens most often in people who are in their 60s or older.

What causes bladder cancer?

Experts don't know what
causes bladder cancer. But smoking cigarettes or being exposed to certain chemicals raises your risk. And like other cancers, changes in the DNA of your
cells seem to play a role.

What are the symptoms?

Blood in the urine is the
main symptom. Other symptoms may include having to urinate often or feeling
pain when you urinate.

These symptoms can be caused by other
problems, including a
urinary tract infection. Always call your doctor if
you see blood in your urine.

How is bladder cancer diagnosed?

To diagnose
bladder cancer, your doctor will:

Ask about your medical history and do a
physical exam, including a vaginal or rectal exam.

Test your urine
to look for blood or abnormal cells.

Do a
cystoscopy, a test that lets your doctor look into
your bladder with a thin, lighted viewing tool. Small tissue samples (biopsies) are taken and looked at under a microscope
to find out if there are cancer cells.

How is it treated?

Treatment choices for bladder
cancer include:

Surgery to remove any cancer. Sometimes
lasers or other methods can be used to get rid of tumors.

The treatment depends a lot on how much the cancer has
grown. Most bladder cancers are treated without having to remove the
bladder.

Sometimes doctors do have to remove the bladder. For some
people, this means having urine flow into a bag outside of the body. But in
many cases, doctors can make a new bladder—using other body tissue—that works
very much like the old one.

Bladder cancer often comes back. The
new tumors can often be treated successfully if they are caught early. So it's very
important to have regular checkups after your treatment is done.

Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.

What increases your chances of getting bladder cancer?

Anything that increases your chances of getting a disease is called a
risk factor. The main risk factors for bladder cancer include:

Smoking. Cigarette smokers are much more
likely than other people to get bladder cancer.

Being older than
40, being male, or being white (Caucasian).

Being exposed to
cancer-causing chemicals, such as those used in the wood, rubber, and textile
industries.

What you eat. A diet high in fried meats and fats
increases your risk for bladder cancer.

Parasites. There is a
parasite that causes schistosomiasis, which can increase your risk. This
condition is sometimes found in developing countries and rarely occurs in North
America.

Cause

The cause of
bladder cancer is not known. Changes in the genetic
material (DNA) of bladder cells may play a role. Chemicals in
the environment and cigarette smoking also may play a role. And when the lining
of the bladder is irritated for a long time, cell changes that lead to cancer
may occur. Some things that cause this are radiation treatment, having
catheters in place for a long time, or having the parasite that causes
schistosomiasis.

Bladder cancer is twice as likely to develop in
smokers than in nonsmokers. Experts believe that smoking causes about half of
all bladder cancers in men and women.1

Exposure to chemicals and other
substances at work—including dyes, paints, leather dust, and others—may also
cause bladder cancer.

Symptoms

The most common symptoms of
bladder cancer include:

Blood or blood clots in the urine (hematuria).
Hematuria occurs in 8 or 9 out of 10 people who have bladder cancer and is the
most common symptom. Usually it isn't painful.

The symptoms of bladder cancer may be similar to symptoms
of other bladder conditions.

What Happens

Bladder cancer
is the rapid, uncontrolled growth of abnormal cells in the bladder. Cancer
usually begins in the lining of the bladder. The cancerous cells may spread
through the lining into the muscular wall of the bladder.

Invasive bladder
cancer may spread to
lymph nodes, other organs in the pelvis (causing
problems with kidney and bowel function), or other organs in the body, such as
the liver and lungs.

Your treatment will depend on how far the cancer has spread.

Most bladder cancer is found early, before it has spread into the bladder wall. Surgery can usually remove these tumors. But bladder cancer often comes back, so you may also get other treatments, such as chemotherapy or immunotherapy, to lower the chances of that happening.

What Increases Your Risk

The main risk factors for
bladder cancer include:

Smoking. Cigarette smokers are much more
likely than other people to get bladder cancer.

Chemical exposure. Bladder cancer has been linked to chemicals
called aromatic amines. These chemicals are found in many products, including dyes, paints,
solvents, inks, and the dust from leather. This risk may also depend on how
much and how often a person was exposed to these chemicals.

Being older. Your risk goes up as you get older. Most people
who get bladder cancer are close to their 70s.

Being a white male. Men are 4 times more likely to get bladder cancer than women. And white men are twice as likely to get it as African-American men.1

Some cancer treatments, such as radiation therapy to the belly or pelvis.

Some chemotherapy medicines, such as cyclophosphamide.

A diet that
is high in nitrates or rich in meat and fatty foods.

Schistosomiasis, which is an infection caused by a parasite. It's sometimes
found in developing countries and rarely occurs in North America.

When To Call a Doctor

If you have been diagnosed with
bladder cancer, be sure to follow your doctor's
instructions about calling when you have problems, new symptoms, or symptoms
that get worse.

Exams and Tests

To find out whether
bladder cancer may be the cause of your urinary
symptoms, your doctor will:

Do a physical exam. This may include
a
rectal exam, a
prostate exam for men, or a
pelvic exam for women.

Ask questions about your medical history,
including:

Your smoking history.

Your possible exposure to cancer-causing chemicals.

Your family history of cancer.

Order a urine test and
urine culture to check for the presence of blood,
infection, and other abnormal cells. A urine test may also be done to look for tumor markers, which can be signs of cancer.

Cystoscopy

You will have a cystoscopy, a test that allows your doctor to look at your bladder with a thin, lighted tube. The doctor can use the same tube to take small tissue samples (biopsies) of any abnormal areas. The samples will be looked at under a microscope to find out whether cancer cells are present and what the cells look like.

Tests to determine stage and grade

Bladder cancer is classified by
stage and grade. The stage is determined by the
cancer growth in the bladder wall and how far it has spread to nearby tissues
and other organs, such as the lungs, the liver, or the bones. The grade of
bladder cancer is determined by how the cancer cells look in comparison with
normal bladder cells.

Your doctor finds out the stage and grade of
your bladder cancer by gathering information from several tests, including:

Early detection of returning cancer

Bladder cancer often comes back, so it's important to have regular checkups. Then, if the cancer does come back, you have a better chance of finding it early enough for successful treatment.

Treatment Overview

The choice of treatment and the
long-term outcome (prognosis) for people who have
bladder cancer depend on the
stage and grade of cancer. When deciding about your treatment, your doctor also considers your age, overall
health, and quality of life.

Bladder cancer has a better chance of being treated successfully if it is found early.

Treatment choices for bladder cancer may include:

Surgery to remove the cancer. Surgery,
either alone or along with other treatments, is used in most cases.

Chemotherapy to
destroy cancer cells using medicines. Chemotherapy may be given before or after
surgery.

Radiation therapy to destroy cancer cells using
high-dose X-rays or other high-energy rays. Radiation therapy may also be given
before or after surgery and may be given at the same time as
chemotherapy. For more information, see Other Treatment.

Immunotherapy. This treatment causes your body's natural
defenses, known as your
immune system, to attack bladder cancer cells. For more information, see Medications.

Stages and grades of bladder cancer

Stage 0: Cancer cells are only on the surface of the inner layer of the bladder. This may be called carcinoma in situ.

Stage I: Cancer has grown deeper into the inner layer but not into the muscle layer.

Stage II: Cancer has grown into the muscle layer of the bladder.

Stage III: Cancer has grown through the muscle layer and into nearby organs, such as the prostate, uterus, or vagina.

Stage IV: Cancer has grown into the wall of the pelvis or the belly but not into any lymph nodes. Or the cancer has spread into at least one lymph node or to another part of the body, such as the liver, lungs, or bones.

The grade of bladder cancer is usually either low-grade (LG) or high-grade (HG). High-grade tumors tend to grow faster. They are also more likely to spread than low-grade tumors. When your doctor knows the grade of your cancer, this information will help him or her choose the best treatment plan for you.

More information about bladder cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/bladder.

Bladder cancer that comes back

After initial treatment for
bladder cancer, it is important to receive follow-up
care, because bladder cancer often comes back (recurs). Your doctor will set up a regular schedule of checkups and tests.

Bladder cancer may recur in the bladder, or it may spread (metastasize) to other parts of
the body. Recurrent bladder cancer may be treated with surgery or
chemotherapy to slow cancer growth and relieve
symptoms.

Participation in a
clinical trial may be recommended if you have been
diagnosed with recurrent bladder cancer.

Body image and sexual problems

Sexual problems can be caused by physical or psychological factors related to the cancer or its treatment. You may experience less sexual pleasure or lose your desire to be sexually intimate.

Women who have their bladder removed (radical
cystectomy) will also have their
ovaries and
uterus removed. They cannot become pregnant and may
experience
menopause soon after having this surgery.

Men who have their prostate glands and seminal vesicles removed
may have erection problems and will no longer produce semen.

Your feelings about your body may change after
treatment for cancer. Managing your feelings about your body may involve talking openly
about your concerns with your partner and discussing your feelings with your
doctor. Your doctor may also be able to refer you to groups that can offer
support and information.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

End-of-life care

For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.

Home Treatment

The side effects of bladder cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects.

For
diarrhea, such as small, frequent sips of water and bites of salty crackers.

For constipation, such as plenty of water and fiber in your diet. Do not use a laxative without first talking to
your doctor.

Other issues that can be treated at home include:

Sleep problems. If you have trouble sleeping, try having
a regular bedtime and getting exercise daily.

Feeling very tired. If you lack energy or become weak easily, try to manage your energy and get extra rest.

Hair loss. Hair loss may be unavoidable. But using
mild shampoos and avoiding damaging hair products will reduce irritation of
your scalp.

Pain. Home treatment can help you manage pain. Be sure to talk with your doctor about any home treatment you use.

Handling the stress of having cancer

Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.

These ideas may help:

Get the support you need. Spend time with people who care about you, and let them help you.

Medications

Medicines may be used to control the growth
of
bladder cancer cells and to relieve symptoms.
These medicines may be taken by mouth, injected
into a vein (intravenous, or IV), or delivered directly into the bladder using a catheter.

Immunotherapy, also called biological therapy, uses medicines
that cause your body's
immune system to attack cancer cells in your bladder.
It is most often used for early-stage bladder cancer. It may also be used after a transurethral resection (TUR) to help keep cancer from coming back.

Medicine choices

Chemotherapy medicines

Gemcitabine and
cisplatin

MVAC, a combination of
methotrexate, vinblastine, doxorubicin, and
cisplatin

Immunotherapy medicines

Side effects of immunotherapy vary
depending on the medicine.
Bacillus Calmette-Guerin (BCG) is a type of bacteria related to the bacteria that cause tuberculosis (TB). BCG is used in TB vaccines. Also, BCG is placed into the bladder to treat bladder cancer. With BCG, the side effects
may include:

Fever.

Joint pain.

Inflammation of the prostate.

Disseminated tuberculosis.

Surgery

Surgery is used to treat most
stages of
bladder cancer.

Transurethral resection (TUR) is surgery done through the urethra. A thin, lighted tube called a cystoscope is used to remove or destroy tumors in the bladder.

Partial cystectomy removes only part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area.

Radical cystectomy removes all of the bladder as well as nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells.

Urinary diversion is surgery that makes a new way for your body to store urine. This can be done with a pouch created inside your body from part of your intestines, called a continent reservoir. Or the surgeon may make an artificial opening, called an ileal conduit, and you will wear a flat bag to store urine outside your body.

Other Treatment

Radiation treatment

Radiation treatment for
bladder cancer uses high-energy X-rays to kill cancer
cells and shrink tumors. It may be given after surgery. It may be used along with chemotherapy. Sometimes it is used instead of surgery or chemotherapy.

External beam radiation comes from a machine outside
the body. The machine aims radiation at the area where the cancer cells are
found.

Internal radiation uses needles, seeds, wires, or catheters that contain
radioactive materials placed close to or directly into the bladder.

Which
treatment you receive will depend on the type and stage of your cancer.

In women, changes to the cells lining the vagina. These changes can make intercourse difficult or painful.

In men, erection problems if the nerves that control erection were affected by radiation.

Clinical trials

Your doctor may talk to you about joining a research study called
a clinical trial if one is available in your area. Clinical trials are research studies to look for ways
to improve treatments for bladder cancer. Experts are doing studies on:

Chemoprevention for early-stage bladder cancer. This is the
use of medicines or vitamins to reduce the risk of getting cancer or having
cancer come back.

Photodynamic therapy. This uses medicine and a
special light to treat the cancer.

For some people with bladder cancer, clinical trials may offer the best treatment available.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.

Other Places To Get Help

Organizations

American Cancer Society (ACS)

Web Address:

www.cancer.org

NIH: National Cancer Institute (U.S.)

Web Address:

www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)

National Cancer Institute (2010). What You Need To Know About Bladder Cancer (NIH Publication No. 10-1559). Available online: http://www.cancer.gov/cancertopics/wyntk/bladder.

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